Lymphedema
What is lymph?
Lymph is a milky fluid that contains white blood cells. White blood cells help fight infections.
Lymph vessels, like blood vessels, run throughout the body. They carry lymph, cells and other material.
Lymph from tissues and organs drains into the lymph vessels and is carried to the lymph nodes where it’s filtered.
Lymph nodes are found throughout the body. The ones near the breast (see image below) can be affected by breast cancer treatment.
Source: National Cancer Institute (www.cancer.gov)
What is lymphedema?
During breast cancer surgery (mastectomy or lumpectomy), some of the lymph nodes in your underarm (axillary lymph nodes) may be removed. They are checked for cancer.
When axillary lymph nodes are removed during breast surgery (with sentinel node biopsy or axillary dissection) or are treated with radiation therapy, some of the lymph vessels can become blocked. This may prevent lymph fluid from leaving the tissue in your arm below the area where the lymph nodes were removed.
Lymphedema occurs when lymph fluid collects in your arm, causing it to swell (edema). Lymphedema can also occur in your hand, fingers, chest/breast or back.
The swelling may be so slight it’s barely seen or felt. Or, it may be so great your arm or other affected area grows very large.
In severe cases, lymphedema can cause pain and limit movement. Have one arm larger than the other (or swelling in another area), even if the change is small, can be upsetting.
Learn about sentinel node biopsy, axillary dissection and the risk of lymphedema.
For a picture of lymphedema, visit the Society for Vascular Surgery website.
Who gets lymphedema?
Lymphedema is related to axillary lymph node surgery and radiation therapy, but it’s not clear why some people get lymphedema and others don’t.
Some factors that increase risk include [18-24,204]:
- Having axillary lymph nodes removed (the more nodes removed, the greater the risk)
- Radiation therapy to the axillary lymph node area
- Having axillary lymph nodes removed plus radiation therapy to the axillary lymph node area
- Having a large number of axillary lymph nodes that contain cancer
- Infections in the area after breast surgery
- Being overweight or obese
Breast reconstruction and lymphedema
Whether or not a woman has breast reconstruction after a mastectomy does not appear to affect her risk of lymphedema [25-29]. The type of breast reconstruction a woman chooses also does not appear to affect risk [25-29].
How often does lymphedema occur?
Today, most people treated for breast cancer don’t get lymphedema since modern surgery removes fewer axillary lymph nodes than in the past.
Compared to the past, the cases that do occur are usually less severe in terms of the impact on movement and the way the arm looks.
Sentinel node biopsy versus axillary dissection
In the past, people treated for breast cancer almost always had a procedure called axillary dissection to remove axillary lymph nodes.
Now, most people have a less invasive procedure called sentinel node biopsy. This procedure removes fewer lymph nodes than axillary dissection, so there’s less risk of lymphedema [18,22-24,204].
Women who have sentinel node biopsy are about 3-4 times less likely to develop lymphedema than those who have an axillary dissection [23,30].
One year after breast surgery [20,26,31]:
- Fewer than 5 percent of women who had sentinel node biopsy develop lymphedema
- 10-20 percent of women who had axillary dissection develop lymphedema
Learn more about sentinel node biopsy and axillary dissection.
When does lymphedema occur?
Lymphedema usually develops within 3 years of breast surgery [22,24,204]. However, it can occur years later [22,24,204].
In cases when lymphedema occurs right after surgery, it usually only lasts a short period of time and then goes away.
Signs and symptoms
Signs and symptoms of lymphedema include [18,22]:
- Swelling in the arm or hand (for example, your rings or watch feels tighter)
- Feeling of tightness, heaviness or fullness in the arm, hand, chest/breast or back
- Feeling of tightness in the skin or a thickening of the skin
- Pain or redness in the arm or hand
If you notice early signs or symptoms of lymphedema, talk with your health care provider.
Most cases of lymphedema can be managed, but the signs and symptoms don’t usually go away completely. When caught early, treatment can reduce some signs and symptoms and stop them from getting worse.
For a picture of lymphedema, visit the Society for Vascular Surgery website.
Screening and diagnosis
The most common way health care providers check for lymphedema is by measuring upper and lower arm widths.
Measurements should be taken before surgery to have a comparison for measures taken after surgery [204].
Other screening methods include perometers, bioimpedance measures, water displacement, taking pictures, asking the person about their symptoms and special imaging of the lymph nodes called lymphoscintigraphy [18,22,24,32-33].
Some studies show monitoring for lymphedema within the first 3 months after surgery may lead to earlier diagnosis [32,34].
Treatment
Many cases of lymphedema will not completely go away. However, treatment can reduce pain and swelling in the affected arm. It can also improve movement.
Standard lymphedema treatment includes complex decongestive therapy. This approach aims to decrease swelling and infection through a combination of [18,22,24]:
- Skin and nail care
- Compression bandages or sleeves (these apply pressure around the arm and help push lymph fluid out of the arm)
- Exercises (closing and opening a fist, for example)
- Manual lymphatic drainage (a special type of massage)
- Physical therapy
Complex decongestive therapy usually is given in 15-30 sessions over 4-6 weeks [21]. After that, you continue the therapy on your own [21].
Other treatments may include [21-22,35,204]:
- Exercise
- Compression device (a pump connected to a sleeve that inflates and deflates to apply pressure to the arm)
- Weight loss
- Surgery
Before starting any of these therapies, discuss them with your health care provider.
Many therapies are given by a physical therapist. Your health care provider may recommend a physical therapist or you can find one through the National Lymphedema Network or the Lymphology Association of North America.
Other treatments for lymphedema, such as lymph node transfer and lymphovenous bypass, are under study [21,36-38].
Exercise
In the past, there was some concern exercise might increase the risk of lymphedema after breast cancer surgery and worsen symptoms in those who already had lymphedema.
However, after recovery from breast surgery, arm exercises (such as weight-lifting) don’t appear to increase the risk of lymphedema [24,39-42]. (It’s best to avoid strenuous exercise right after breast surgery though.)
Studies also show weight-lifting (moderate, in a supervised setting) can reduce symptoms of lymphedema in breast cancer survivors, as well as improve body image, sexuality and physical strength [43-45].
Talk with your health care provider before starting an exercise program to manage lymphedema.
Learn more about the benefits of exercise for breast cancer survivors and find guidelines on physical activity.
Reducing risk
Although there’s no proven way to prevent lymphedema, you can:
- Maintain a healthy weight
- Be aware lymphedema is a possible side effect of breast cancer treatment
- Seek care when you first notice signs or symptoms
- Take steps to reduce the risk of injury and infection
Injury or infection to the arm may trigger lymphedema [22]. So, it’s best to take steps to reduce the risk of injury or infection.
Although the tips below haven’t been proven in clinical trials, they may work for some people (especially those who have had axillary node dissection).
Tips to reduce the risk of injury or infection to the arm |
If you have an infection, injury or any of the symptoms listed above, see your health care provider. |
Adapted from selected materials [22,24]. |
Air travel and length of flights don’t appear to increase the risk of lymphedema [19,204]. However, if you have a long flight, it may be helpful to wear a compression sleeve and to massage your arm during the flight [24].
A note if you are traveling by air |
Susan G. Komen® wants to ensure people who have breast cancer are treated with respect and dignity. When you travel by air, these steps may be helpful:
Learn about TSA screening if you wear a breast prosthesis. Learn about TSA screening if you wear a wig, scarf or other head covering. If you have concerns about airline security screening, visit the TSA website. |
Calling attention to lymphedema
Many people don’t know lymphedema is a possible side effect of breast cancer treatment, but it can be a lifelong concern once it develops.
Try to take steps to reduce your risk of lymphedema. Seek care if it does develop. If you have any signs or symptoms of lymphedema, see your health care provider.
The National Lymphedema Network is working to increase awareness of lymphedema.
Susan G. Komen Supports the Lymphedema Treatment Act |
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The Lymphedema Treatment Act has been reintroduced in both the U.S. Senate and House with overwhelming support. Currently, Medicare does not fully cover the compression garments, bandages, and devices needed for comprehensive lymphedema treatment. Without this coverage, people in need of this treatment may have high out-of-pocket costs to treat their lymphedema. This is a barrier to care. When people can’t afford the things they need for standard treatment of lymphedema, it puts them at risk for infection, hospitalization and further health problems. The Lymphedema Treatment Act will ensure Medicare covers needed compression supplies. |
Komen Financial Assistance Program |
Susan G. Komen® created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals. Funding is available for eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage IV). To learn more about this program and other helpful resources, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org. Se habla español. |
Resources
Komen Financial Assistance Program
Provides financial assistance for lymphedema care and supplies, as well as other expenses related to breast cancer care.
www.komen.org
Living Beyond Breast Cancer
Find information on lymphedema.
www.lbbc.org/
Lymphatic Education and Research Network
Find clinical trials and other information on lymphedema.
www.lymphaticnetwork.org/
Lymphology Association of North America (LANA)
Find a list of LANA-certified physical therapists.
www.clt-lana.org
National Cancer Institute—Lymphedema
Find information on lymphedema.
www.cancer.gov
National Lymphedema Network
Find a support group, a physical therapist, information on lymphedema and financial assistance for compression garments.
www.lymphnet.org
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.
Updated 04/27/22
